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SIU Investigator

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Hi, we're Oscar. We're hiring an Associate, SIU Investigator to join our SIU team.

Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role

The Associate, Special Investigations Unit Investigator analyzes data, and managing investigative caseload of complex cases from identification through to resolution including overpayment recovery, measuring behavior change and completing necessary reporting to meet monetary and caseload targets through investigations and internal process improvements for Fraud, Waste and Abuse (FWA) recoupments and savings.

You will report to the Associate Director, SIU.

Work Location:

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.

You must reside in one of the following states: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $84,800 - $111,300 per year. The base pay for this role in all other locations is: $76,320 - $100,170 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

Identify and conduct investigations into known or suspected FWA with high autonomy.
Develop documentation to substantiate findings, including formal reports, graphs, audit logs, and other supporting documentation.
Meet targets through investigations and internal process improvements– which should, at least initially, increase year-over-year – for FWA recoupments and savings.
Perform analysis to inform identification of similar claims or cases and associated savings.
Refine process and practices to seek greater efficiency and better use of data and technology.
Maintain relationships with and respond to requests from regulatory and law enforcement officials; Perform oversight for delegates or act as a liaison with clients and our teams.
Participate in the development and presentation of FWA-related education for Oscar teams.
Compliance with all applicable laws and regulations.
Other duties as assigned.

Qualifications

Bachelor’s Degree in Criminal Justice or a related field or commensurate experience
5+ years of insurance claims investigation experience or professional investigation experience with law enforcement agencies.
2+ years of experience with fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity.

Bonus Points

Experience working in health insurance across several products specifically with claims processing, billing, reimbursement, or provider contracting.
Experience with HIPAA, data privacy, and/or data security processes
Experience working with regulators governing (public or private) health insurance carriers.
Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), or similar.
Certified Professional Coder (CPC) or similar.

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Notice to Job Applicants.

Oscar Health Glassdoor Company Review

3.2

Oscar Health DE&I Review

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CEO of Oscar Health

Mark Bertolini

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Average salary estimate

$93810 / YEARLY (est.)

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$76320K

$111300K

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What You Should Know About SIU Investigator, Oscar Health

Hello there! We're Oscar, and we’re on the lookout for an engaging and detail-oriented Associate, SIU Investigator to join our Special Investigations Unit (SIU) team. At Oscar, we’re not just a health insurance company; we’re a vibrant team leveraging cutting-edge technology to provide the best for our members. Founded in 2012, our mission is to ensure our members feel like they're being cared for like family. As the Associate, SIU Investigator, you'll dive deep into data, manage a diverse caseload of complex investigations, and work through cases from start to finish, focusing on fraud, waste, and abuse (FWA). Your responsibilities will involve developing comprehensive documentation of your findings and hitting those all-important targets for recouping FWA losses. You'll have the autonomy to identify potential fraud cases and refine internal processes to ensure we’re maximizing efficiency. Collaboration is vital; you'll interact with regulatory and law enforcement officials and help educate other Oscar teams on FWA-related practices. And don’t worry, while we promote a blended work culture, you can work remotely—but we hope to see you in one of our offices if you're nearby! Working with us also means great perks like unlimited vacation, annual bonuses, and a comprehensive benefits package. If you're passionate about making a difference in health insurance and meet the qualifications, we can’t wait to hear from you!

Frequently Asked Questions (FAQs) for SIU Investigator Role at Oscar Health

What are the responsibilities of an Associate, SIU Investigator at Oscar?

As an Associate, SIU Investigator at Oscar, your main responsibilities will include investigating known or suspected fraud, waste, and abuse (FWA) cases with a high degree of autonomy. You will be responsible for documenting your findings in formal reports, analyzing data to identify similar claims, and continuously refining processes to enhance efficiency in handling FWA recoupments and savings.